FITZ EXIT EXAM NURSE PRACTITIONER
BOARD REVIEW QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ||
100% GUARANTEED PASS!!
<LATEST VERSION>
1.
A 62-year-old male presents with progressive dyspnea on exertion and lower
extremity edema. On exam, he has elevated jugular venous pressure and bibasilar
crackles. His echocardiogram shows an ejection fraction of 35%. Which of the
following is the most appropriate first-line pharmacologic therapy?
A) Hydrochlorothiazide
B) Lisinopril
C) Amlodipine
D) Digoxin
Answer: B) Lisinopril
Rationale:
This patient presents with systolic heart failure (reduced EF) and signs of volume
overload. ACE inhibitors, such as lisinopril, are first-line therapy because they
reduce mortality, morbidity, and hospitalizations in HFrEF. Diuretics (e.g.,
hydrochlorothiazide) relieve symptoms but do not improve survival. Amlodipine is
primarily used for hypertension and angina. Digoxin may help symptoms but does
not reduce mortality.
,2.
A 28-year-old woman presents with dysuria, frequency, and urgency. Urinalysis
shows positive nitrites and leukocyte esterase. She has no history of recurrent
UTIs. Which of the following is the first-line treatment?
A) Ciprofloxacin 500 mg BID × 3 days
B) Nitrofurantoin 100 mg BID × 5 days
C) Trimethoprim 200 mg BID × 10 days
D) Amoxicillin 500 mg TID × 7 days
Answer: B) Nitrofurantoin 100 mg BID × 5 days
Rationale:
Uncomplicated urinary tract infections in women are most effectively treated with
a 5-day course of nitrofurantoin. Ciprofloxacin is reserved for complicated
infections due to resistance and safety concerns. Trimethoprim may be used if local
resistance is low. Amoxicillin is generally less effective due to high resistance
rates.
3.
A 45-year-old male with type 2 diabetes presents with a fasting glucose of 180
mg/dL and HbA1c of 9.2%. He is currently on metformin 1000 mg BID. Which of
the following is the best next step?
A) Increase metformin to 1500 mg BID
B) Add a GLP-1 receptor agonist
C) Start insulin immediately
D) Switch to sulfonylurea
Answer: B) Add a GLP-1 receptor agonist
Rationale:
For patients with type 2 diabetes and HbA1c > 9% on metformin, adding a GLP-1
receptor agonist or SGLT2 inhibitor is guideline-directed therapy due to efficacy,
cardiovascular benefit, and weight loss properties. Increasing metformin alone is
unlikely to achieve target control. Insulin may be considered if symptomatic
hyperglycemia or metabolic decompensation occurs.
,4.
A 34-year-old female presents with fever, sore throat, and anterior cervical
lymphadenopathy. Rapid strep test is negative. Which is the next best step?
A) Prescribe azithromycin
B) Send throat culture
C) Start empiric amoxicillin
D) No treatment needed
Answer: B) Send throat culture
Rationale:
Rapid antigen tests can have false negatives. In adults with symptoms suggestive
of streptococcal pharyngitis but negative rapid test, a throat culture confirms the
diagnosis before initiating antibiotics. Empiric antibiotics are not recommended
without confirmation.
5.
A 72-year-old male with hypertension and CKD stage 3 is found to have a
potassium of 5.7 mEq/L. He is on lisinopril. Which of the following is the safest
immediate management?
A) Discontinue lisinopril
B) Start potassium binder (e.g., patiromer)
C) Administer IV insulin with glucose
D) Restrict dietary potassium only
Answer: C) Administer IV insulin with glucose
Rationale:
This patient has hyperkalemia with potential risk of cardiac arrhythmias.
Immediate stabilization is indicated using IV insulin with glucose to shift
potassium intracellularly. Lisinopril may be held after acute stabilization, but
immediate discontinuation alone does not address risk. Dietary restriction is
insufficient for acute management.
, 6.
A 55-year-old female presents with chronic fatigue, weight gain, cold intolerance,
and dry skin. Lab results: TSH 12 mIU/L, free T4 low. What is the most
appropriate management?
A) Start levothyroxine
B) Order repeat TSH in 3 months
C) Start methimazole
D) Refer to endocrinology immediately
Answer: A) Start levothyroxine
Rationale:
The patient presents with primary hypothyroidism. Levothyroxine is first-line
therapy. Methimazole is used for hyperthyroidism. Immediate referral is not
required unless complicated or refractory. Repeat testing without treatment is
inappropriate with symptomatic hypothyroidism.
7.
A 29-year-old male presents with acute asthma exacerbation. He is using albuterol
every 4 hours with minimal relief. Peak expiratory flow is 60% predicted. Which is
the most appropriate next step?
A) Continue albuterol only
B) Add oral corticosteroids
C) Start inhaled tiotropium
D) Prescribe a long-acting beta-agonist
Answer: B) Add oral corticosteroids
Rationale:
An asthma exacerbation with PEF < 80% and poor response to short-acting
bronchodilator requires systemic corticosteroids to reduce inflammation. Long-
acting beta-agonists are not for acute exacerbations. Tiotropium is primarily for
COPD management.
BOARD REVIEW QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ||
100% GUARANTEED PASS!!
<LATEST VERSION>
1.
A 62-year-old male presents with progressive dyspnea on exertion and lower
extremity edema. On exam, he has elevated jugular venous pressure and bibasilar
crackles. His echocardiogram shows an ejection fraction of 35%. Which of the
following is the most appropriate first-line pharmacologic therapy?
A) Hydrochlorothiazide
B) Lisinopril
C) Amlodipine
D) Digoxin
Answer: B) Lisinopril
Rationale:
This patient presents with systolic heart failure (reduced EF) and signs of volume
overload. ACE inhibitors, such as lisinopril, are first-line therapy because they
reduce mortality, morbidity, and hospitalizations in HFrEF. Diuretics (e.g.,
hydrochlorothiazide) relieve symptoms but do not improve survival. Amlodipine is
primarily used for hypertension and angina. Digoxin may help symptoms but does
not reduce mortality.
,2.
A 28-year-old woman presents with dysuria, frequency, and urgency. Urinalysis
shows positive nitrites and leukocyte esterase. She has no history of recurrent
UTIs. Which of the following is the first-line treatment?
A) Ciprofloxacin 500 mg BID × 3 days
B) Nitrofurantoin 100 mg BID × 5 days
C) Trimethoprim 200 mg BID × 10 days
D) Amoxicillin 500 mg TID × 7 days
Answer: B) Nitrofurantoin 100 mg BID × 5 days
Rationale:
Uncomplicated urinary tract infections in women are most effectively treated with
a 5-day course of nitrofurantoin. Ciprofloxacin is reserved for complicated
infections due to resistance and safety concerns. Trimethoprim may be used if local
resistance is low. Amoxicillin is generally less effective due to high resistance
rates.
3.
A 45-year-old male with type 2 diabetes presents with a fasting glucose of 180
mg/dL and HbA1c of 9.2%. He is currently on metformin 1000 mg BID. Which of
the following is the best next step?
A) Increase metformin to 1500 mg BID
B) Add a GLP-1 receptor agonist
C) Start insulin immediately
D) Switch to sulfonylurea
Answer: B) Add a GLP-1 receptor agonist
Rationale:
For patients with type 2 diabetes and HbA1c > 9% on metformin, adding a GLP-1
receptor agonist or SGLT2 inhibitor is guideline-directed therapy due to efficacy,
cardiovascular benefit, and weight loss properties. Increasing metformin alone is
unlikely to achieve target control. Insulin may be considered if symptomatic
hyperglycemia or metabolic decompensation occurs.
,4.
A 34-year-old female presents with fever, sore throat, and anterior cervical
lymphadenopathy. Rapid strep test is negative. Which is the next best step?
A) Prescribe azithromycin
B) Send throat culture
C) Start empiric amoxicillin
D) No treatment needed
Answer: B) Send throat culture
Rationale:
Rapid antigen tests can have false negatives. In adults with symptoms suggestive
of streptococcal pharyngitis but negative rapid test, a throat culture confirms the
diagnosis before initiating antibiotics. Empiric antibiotics are not recommended
without confirmation.
5.
A 72-year-old male with hypertension and CKD stage 3 is found to have a
potassium of 5.7 mEq/L. He is on lisinopril. Which of the following is the safest
immediate management?
A) Discontinue lisinopril
B) Start potassium binder (e.g., patiromer)
C) Administer IV insulin with glucose
D) Restrict dietary potassium only
Answer: C) Administer IV insulin with glucose
Rationale:
This patient has hyperkalemia with potential risk of cardiac arrhythmias.
Immediate stabilization is indicated using IV insulin with glucose to shift
potassium intracellularly. Lisinopril may be held after acute stabilization, but
immediate discontinuation alone does not address risk. Dietary restriction is
insufficient for acute management.
, 6.
A 55-year-old female presents with chronic fatigue, weight gain, cold intolerance,
and dry skin. Lab results: TSH 12 mIU/L, free T4 low. What is the most
appropriate management?
A) Start levothyroxine
B) Order repeat TSH in 3 months
C) Start methimazole
D) Refer to endocrinology immediately
Answer: A) Start levothyroxine
Rationale:
The patient presents with primary hypothyroidism. Levothyroxine is first-line
therapy. Methimazole is used for hyperthyroidism. Immediate referral is not
required unless complicated or refractory. Repeat testing without treatment is
inappropriate with symptomatic hypothyroidism.
7.
A 29-year-old male presents with acute asthma exacerbation. He is using albuterol
every 4 hours with minimal relief. Peak expiratory flow is 60% predicted. Which is
the most appropriate next step?
A) Continue albuterol only
B) Add oral corticosteroids
C) Start inhaled tiotropium
D) Prescribe a long-acting beta-agonist
Answer: B) Add oral corticosteroids
Rationale:
An asthma exacerbation with PEF < 80% and poor response to short-acting
bronchodilator requires systemic corticosteroids to reduce inflammation. Long-
acting beta-agonists are not for acute exacerbations. Tiotropium is primarily for
COPD management.
